Current practice of occupational therapy for children with autism.

OBJECTIVE: The purpose of this study was to examine the current practice patterns of occupational therapists experienced in working with children with autism spectrum disorders. METHOD: Occupational therapists experienced in providing services to 2-year-old to 12-year-old children with autism completed a mail questionnaire describing practice patterns, theoretical approaches, intervention techniques, and preferred methods of preparation for work with children with autism. RESULTS: Of those contacted, 72 occupational therapists met the study criteria and returned completed questionnaires. Practice patterns included frequent collaboration with other professionals during assessment and intervention. Intervention services were typically provided in a one-to-one format with the most common techniques being sensory integration (99%) and positive reinforcement (93%). Theoretical approaches included sensory integration (99%), developmental (88%), and behavioral (73%). Evaluations relied heavily on nonstandardized tools and clinical observations. Educational methods identified as most helpful were weekend workshops (56%) and on-the-job training (52%). CONCLUSION: This study clarified the nature of current occupational therapy practice patterns for 2-year-old to 12-year-old children with autism. Additional studies are needed to examine the efficacy of current evaluation and intervention methods, as well as to explore the relevance of available standardized assessments for this population.

Current trends in assistive technology education in entry-level occupational therapy curricula.

OBJECTIVE: This replication study investigated what changes, if any, occurred in the education of entry-level occupational therapy students relative to assistive technology between 1989 and 1994-1995. METHOD: A questionnaire was mailed to all entry-level occupational therapy programs in the United States (N = 79). The response rate was 88.6% (n = 70). Results were compared with those of a similar survey that examined the same issues in 1989. RESULTS: Assistive technology education had increased from 1989 to 1994-1995 in 11 identified areas. The highest increases were found in environmental access and robotics, sensory aids, augmentative communication, and prosthetics and orthotics. Only 10% of the respondent programs had less than 20 hours of assistive technology education compared with 50% in the earlier study. Thirty (43%) programs included one or more technology courses in the curriculum compared with 17 (29%) in 1989, and 62 (89%) programs included assistive technology content in lectures or units throughout the curriculum compared with 32 (54%) in 1989. CONCLUSION: Occupational therapy educators are placing more emphasis on assistive technology education than they did in 1989 and are learning the skills to teach this content. If this trend continues, we will see assistive technology content taught in all occupational therapy programs in the next millennium.

The role of play in pediatric occupational therapy.

OBJECTIVE: This study examined the roles that play occupies within current occupational therapy practice with preschoolers. METHOD: Two hundred twenty-four pediatric occupational therapists completed mail questionnaires designed to ascertain how they use play in their practice, their knowledge and use of play assessments, and potential constraints on their use of play. RESULTS: Although respondents indicated that play was important in motivating children and frequently used play as a treatment modality or reinforcer, they less frequently assessed play behaviors or wrote treatment goals and objectives related to play. Differences were found between school-based and non-school-based respondents regarding the discipline or model that addresses play in the work setting, the use of play assessments, and constraints that limit the use of play in the work setting. CONCLUSION: The results suggest a need for increasing the emphasis on play in entry-level curricula and continuing education, improving clinician access to valid and reliable play assessments, and completing studies designed to examine the use and efficacy of play in occupational therapy intervention.

Use of aides in occupational therapy practice.

OBJECTIVES: This study examined the use of aides in occupational therapy practice, the supervision and training of aides, and practitioners' attitudes toward the use of aides. METHOD: A questionnaire was mailed to a systematically selected sample of 510 occupational therapists and occupational therapy assistants. The response rate was 74%. RESULTS: The use of occupational therapy aides is prevalent in a variety of settings. Forty percent of respondents reported that they currently work with aides, whereas 23% reported that they have never worked with aides. Occupational therapy aides perform a variety of tasks and receive various levels and amounts of supervision and training. Of those respondents who delegated specific skilled tasks to aides, 76% reported daily contact for purposes of supervision and training. Nineteen percent who currently work or have worked with aides reported being in a situation where an ethical issue arose related to aide use. CONCLUSION: On the basis of the data, it is suggested that occupational therapy practitioners would benefit from taking a proactive role in determining how aides can be used to maximize service delivery while maintaining quality services. There also appear to be ethical concerns related to appropriate delegation of tasks to aides and to their supervision and training.

Therapists' perceptions of pediatric occupational therapy interventions in self-care.

OBJECTIVES: This study examined the congruence between pediatric occupational therapists' self-care interventions and occupational therapy's philosophical base, which focuses on performance of self-care skills as primary in evaluation and intervention. METHOD: A questionnaire was mailed to 252 therapists serving children ages birth to 6 years. The questionnaire asked for therapists' perceptions about the importance, uniqueness, and frequency of 10 areas of intervention, including self-care. RESULTS: Perceived importance of self-care was found to be strongly related to perceived frequency of self-care intervention. Practice setting was significantly associated with perceptions of uniqueness of self-care, and team membership status was significantly associated with importance of self-care. Most respondents perceived self-care intervention to be important (86%) and unique (80%) to occupational therapy. Seventy percent regularly provided intervention for self-care. CONCLUSIONS: The therapists' perceptions reflected continued regard for self-care as an important and unique area of pediatric occupational therapy but were somewhat discrepant with the actual frequency of self-care interventions.

The use of environmental control units by occupational therapists in spinal cord injury and disease services.

OBJECTIVES: This study investigated issues related to the use of environmental control units (ECUs) with persons who have spinal cord injury and disease (SCI/D) to ascertain what, if any, changes are needed to optimize occupational therapy service delivery in this area. METHOD: A questionnaire was mailed to 120 occupational therapists employed by facilities nationwide that serve person with SCI/D. The survey addressed the occupational therapist's role in the recommendation and use of ECUs, funding sources, and training needs. The response rate was 89% (n = 107). RESULTS: Most respondents (88%) indicated that occupational therapists were the predominant professionals in their facilities who evaluated and recommended ECUs. The majority of respondents (84%) reported using ECUs in hospital-based treatment with persons with SCI/D. However, respondents only recommended ECUs for home use for fewer than 25% of their clients. High cost and the lack of third-party reimbursement were the primary reasons that deterred respondents from recommending ECUs for home use. Fifty-five percent of the respondents reported a need for basic training and 86% for more in-depth education and training in environmental control technologies. CONCLUSION: Outcomes data are needed to support the use of ECUs and to educate third-party payers about the benefits of ECUs for clients with quadriplegia in order to increase rates of reimbursement. In addition, occupational therapists themselves may need improved training in evaluating and training clients in the use of ECU technology.

Use of standardized activities of daily living rating scales in spinal cord injury and disease services.

OBJECTIVE: Although standardized activities of daily living (ADL) rating scales offer advantages in reliability and consistency of reporting, the literature has revealed that most occupational therapists tend to use informal assessments and reporting methods. This study investigated the use of standardized ADL rating scales by occupational therapists who treat patients with spinal cord injury and disease (SCI/D). METHOD: Fifty-two SCI/D rehabilitation sites were selected by stratified random sampling, and surveys were completed by the occupational therapist in each site who worked most extensively with patients with SCI/D: Occupational therapists at 49 of the sites completed the survey. RESULTS: Survey results indicated that 68% of the respondents tend not to use standardized ADL rating scales in their work with SCI/D patients. Of those who used standardized ADL rating scales, the Functional Independence Measure (FIM) was more widely used than any other. Most respondents learned about this measure on the job. Many of the respondents indicated that a limitation of the FIM was its inability to detect progress in their patients with SCI/D: DISCUSSION: The results indicate that although widely used, the FIM may need to be supplemented by other standardized ADL rating scales in order for a therapist to objectively document the progress made by patients with SCI/D: To be able to choose the most appropriate assessment tools, students and practicing therapists need to be educated in a variety of standardized ADL rating scales.

A pilot study comparing mouse and mouse-emulating interface devices for graphic input.

Adaptive interface devices make it possible for individuals with physical disabilities to use microcomputers and thus perform many tasks that they would otherwise be unable to accomplish. Special equipment is available that purports to allow functional access to the computer for users with disabilities. As technology moves from purely keyboard applications to include graphic input, it will be necessary for assistive interface devices to support graphics as well as text entry. Headpointing systems that emulate the mouse in combination with on-screen keyboards are of particular interest to persons with severe physical impairment such as high level quadriplegia. Two such systems currently on the market are the HeadMaster and the Free Wheel. The authors have conducted a pilot study comparing graphic input speed using the mouse and two headpointing interface systems on the Macintosh computer. The study used a single subject design with six able-bodied subjects, to establish a baseline for comparison with persons with severe disabilities. Results of these preliminary data indicated that the HeadMaster was nearly as effective as the mouse and that it was superior to the Free Wheel for graphics input. This pilot study, however, demonstrated several experimental design problems that need to be addressed to make the study more robust. It also demonstrated the need to include the evaluation of text input so that the effectiveness of the interface devices with text and graphic input could be compared.